Patient-ventilator dyssynchrony detection

• US 10,137,266 B2
• Filed: 01/22/2010
• Issued: 11/27/2018
• Est. Priority Date: 02/25/2009
• Status: Active Grant

• Current Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Original Assignee: Koninklijke Philips N.V.
• Inventors: Shelly, Benjamin Irwin, Shankar, Sankarasubrahmani Uday, Kane, Michael T., Matthews, Gregory Delano, Ressler, Heather Dawn
• Primary Examiner(s): Anderson, Lynne
• Assistant Examiner(s): Boecker, Joseph D
• Application Number:
  US13/202,100
• Publication Number:
  US 20110297155A1
• Time in Patent Office: 3,231 Days
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 2016/0015 inhalation detectors

Abstract

A method of detecting dyssynchrony between a patient and a pressure support system includes receiving patient flow data relating to a flow of gas provided to the patient by the pressure support system, receiving an I/E state signal representing a respiratory phase of the patient as determined by the pressure support system, and analyzing the patient flow data and the I/E state signal and declaring a dyssynchrony for a breath based on at least one of the patient flow data and the I/E state signal. The method includes determining whether at least one of a number of predetermined criterion is satisfied based on at least one of the patient flow data and the I/E state signal, and declaring the dyssynchrony for the breath if it is determined that at least one of the number of predetermined criterion is satisfied.

Claims

1. A method of detecting dyssynchrony between a patient and a pressure support system, comprising:

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing a flow of gas provided to the patient by the pressure support system;

obtaining an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchrony for the breath and outputting a dyssynchrony indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchrony is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, wherein the number of predetermined criterion includes all of;

(i) a number of volume qualified flow slope reversals in the patient flow data for the breath exceeding a predetermined number;

(ii) an incremented tidal volume during at least a portion of an expiratory phase of the breath as indicated by the I/E state signal exceeding a predetermined positive value;

(iii) an absolute value of a tidal volume during the breath exceeds a predetermined value; and

(iv) a tidal volume during an inspiratory phase of the breath as indicated by the I/E state is less than a predetermined negative value.

2. The method according to claim 1, wherein the I/E state signal is generated by the pressure support system.

3. The method according to claim 2, wherein the receiving patient flow data, obtaining and analyzing the patient flow data and the I/E signal are performed by the pressure support system.

4. The method according to claim 2, wherein the receiving patient flow data comprises receiving patient flow data in a dyssynchrony detection apparatus separate from the pressure support system, wherein the obtaining an I/E state signal comprises receiving the I/E state signal from the pressure support system in the dyssynchrony detection apparatus, and wherein the analyzing the patient flow data and the I/E signal is performed by the dyssynchrony detection apparatus.

5. The method according to claim 1, wherein the obtaining an I/E state signal comprises receiving pressure data relating to a pressure of the flow of gas provided to the patient by the pressure support system and generating the I/E state signal based on the pressure data.

6. The method according to claim 5, wherein the receiving patient flow data comprises receiving the patient flow data in a dyssynchrony detection apparatus separate from the pressure support system, wherein the receiving pressure data and the generating the I/E state signal comprises receiving the pressure data in the dyssynchrony detection apparatus and generating the I/E state signal in the dyssynchrony detection apparatus, and wherein the analyzing the patient flow data and the I/E signal is performed by the dyssynchrony detection apparatus.

7. The method according to claim 1, further comprising determining a number of volume qualified flow slope reversals present in the patient flow data for an inspiratory phase and an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the number of volume qualified flow slope reversals, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the number of volume qualified flow slope reversals exceeds a predetermined number.

8. The method according to claim 1, further comprising determining an absolute value of a tidal volume from the patient flow data for an inspiratory phase and an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the absolute value, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the absolute value of a tidal volume exceeds a predetermined value.

9. The method according to claim 1, further comprising determining a length of an expiratory phase of the breath as indicated by the I/E state signal, wherein the declaring a dyssynchrony further comprises declaring the dyssynchrony for the breath if it is determined that the length of an expiratory phase does not exceed a predetermined percentage of a length of an inspiratory phase of the breath as indicated by the I/E state signal.

10. The method according to claim 1, further comprising determining a length of an expiratory phase of the breath as indicated by the I/E state signal, wherein the declaring a dyssynchrony further comprises declaring the dyssynchrony for the breath if it is determined that the length of an expiratory phase does not exceed a predetermined duration.

11. The method according to claim 1, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, the method further comprising generating a dyssynchrony flag waveform based on the plurality of dyssynchronies.

12. The method according to claim 1, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, the method further comprising modifying operation of the pressure support system based on the plurality of dyssynchronies.

13. The method according to claim 1, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, the method further comprising detecting information about a condition of the patient based on the plurality of dyssynchronies.

14. The method according to claim 1, further comprising modifying operation of the pressure support system based on the declared dyssynchrony.

15. The method according to claim 1, further comprising detecting information about a condition of the patient based on the declared dyssynchrony.

16. A method of detecting dyssynchrony between a patient and a pressure support system, comprising:

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing a flow of gas provided to the patient by the pressure support system;

obtaining an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchrony for the breath and outputting a dyssynchrony indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchrony is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, further comprising determining an incremental tidal volume from the patient flow data for at least a portion of an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the incremental tidal volume, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the incremental tidal volume exceeds a predetermined positive value.

17. A method of detecting dyssynchrony between a patient and a pressure support system, comprising:

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing a flow of gas provided to the patient by the pressure support system;

obtaining an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchorny for the breath and outputting a dyssynchorny indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchorny is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, further comprising determining a tidal volume from the patient flow data for an inspiratory phase of the breath as indicated by the I/E state, wherein the at least one of a number of predetermined criterion is based on the tidal volume, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the tidal volume is less than a predetermined negative value.

18. A pressure support system, comprising:

a pressure generating system adapted to produce a flow of gas;

a patient circuit operatively coupled to the pressure generating system to deliver the flow of gas to an airway of a patient; and

a controller operatively coupled to the pressure generating system, the controller being adapted to detect dyssynchrony between the patient and the pressure support system by;

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing the flow of gas provided to the patient by the pressure support system;

receiving an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory as determined by the pressure support system, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchrony for the breath and outputting a dyssynchrony indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchrony is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, wherein the number of predetermined criterion includes all of;

(i) a number of volume qualified flow slope reversals in the patient flow data for the breath exceeding a predetermined number;

(ii) an incremental tidal volume during at least a portion of an expiratory phase of the breath as indicated by the I/E state signal exceeding a predetermined positive value;

(iii) an absolute value of a tidal volume during the breath exceeds a predetermined value; and

(iv) a tidal volume during an inspiratory phase of the breath as indicated by the I/E state is less than a predetermined negative value.

19. The pressure support system according to claim 18, wherein the controller is adapted to determine a number of volume qualified flow slope reversals present in the patient flow data for an inspiratory phase and an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the number of volume qualified flow slope reversals, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the number of volume qualified flow slope reversals exceeds a predetermined number.

20. The pressure support system according to claim 18, wherein the controller is adapted to determine an absolute value of a tidal volume from the patient flow data for an inspiratory phase and an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the absolute value, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the absolute value exceeds a predetermined value.

21. The pressure support system according to claim 18, wherein the controller is adapted to determine a length of an expiratory phase of the breath as indicated by the I/E state signal, wherein the declaring a dyssynchrony further comprises declaring the dyssynchrony for the breath if it is determined that the length of an expiratory phase does not exceed a predetermined percentage of a length of an inspiratory phase of the breath as indicated by the I/E state signal.

22. The pressure support system according to claim 18, wherein the controller is adapted to determine a length of an expiratory phase of the breath as indicated by the I/E state signal, wherein the declaring a dyssynchrony further comprises declaring the dyssynchrony for the breath if it is determined that the length of an expiratory phase does not exceed a predetermined duration.

23. The pressure support system according to claim 18, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, wherein the controller is further adapted to generate a dyssynchrony flag waveform based on the plurality of dyssynchronies.

24. The pressure support system according to claim 18, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, wherein the controller is further adapted to modify operation of the pressure support system based on the plurality of dyssynchronies.

25. The pressure support system according to claim 18, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, wherein the controller is further adapted to detect information about a condition of the patient based on the plurality of dyssynchronies.

26. A pressure support system, comprising:

a pressure generating system adapted to produce a flow of gas;

a patient circuit operatively coupled to the pressure generating system to deliver the flow of gas to an airway of a patient; and

a controller operatively coupled to the pressure generating system, the controller being adapted to detect dyssynchorny between the patient and the pressure support system by;

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing the flow of gas provided to the patient by the pressure support system;

receiving an I/e state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory as determined by the pressure support system, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchorny for the breath and outputting a dyssynchorny indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchorny is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, wherein the controller is adapted to determine an incremental tidal volume from the patient flow data for at least a portion of an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the incremental tidal volume, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the incremental tidal volume exceeds a predetermined positive value.

27. A pressure support system, comprising:

a pressure generating system adapted to produce a flow of gas;

a patient circuit operatively coupled to the pressure generating system to deliver the flow of gas to an airway of a patient; and

a controller operatively coupled to the pressure generating system, the controller being adapted to detect dyssynchorny between the patient and the pressure support system by;

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing the flow of gas provided to the patient by the pressure support system;

receiving an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory as determined by the pressure support system, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory, and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchorny for the breath and outputting a dyssynchorny indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchorny is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, wherein the controller is adapted to determine a tidal volume from the patient flow data for an inspiratory phase of the breath as indicated by the I/E state, wherein the at least one of a number of predetermined criterion is based on the tidal volume, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the tidal volume is less than a predetermined negative value.

28. An apparatus for detecting dyssynchrony between a patient and a pressure support system, comprising:

a housing separate from the pressure support system; and

a controller provided within the housing and operatively coupled to the pressure support system, the controller being adapted to detect dyssynchrony between the patient and the pressure support system by;

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing a flow of gas provided to the patient by the pressure support system;

obtaining an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchrony for the breath and outputting a dyssynchrony indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchrony is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, wherein the number of predetermined criterion includes all of;

(i) a number of volume qualified flow slope reversals in the patient flow data for the breath exceeding a predetermined number;

(ii) an incremental tidal volume during at least a portion of an expiratory phase of the breath as indicated by the I/E state signal exceeding a predetermined positive value;

(iii) an absolute value of a tidal volume during the breath exceeds a predetermined value; and

(iv) a tidal volume during an inspiratory phase of the breath as indicated by the I/E state is less than a predetermined negative value.

29. The apparatus according to claim 28, wherein the receiving patient flow data comprises receiving patient flow data in the apparatus for detecting dyssynchrony from the pressure support system, and wherein the obtaining an I/E state signal comprises receiving the I/E state signal from the pressure support system in the dyssynchrony detection apparatus.

30. The method according to claim 28, wherein the obtaining an I/E state signal comprises receiving pressure data relating to a pressure of the flow of gas provided to the patient by the pressure support system and generating the I/E state signal based on the pressure data.

31. The apparatus according to claim 28, wherein the controller is adapted to determine a number of volume qualified flow slope reversals present in the patient flow data for an inspiratory phase and an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the number of volume qualified flow slope reversals, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the number of volume qualified flow slope reversals exceeds a predetermined number.

32. The apparatus according to claim 28, wherein the controller is adapted to determine an absolute value of a tidal volume from the patient flow data for an inspiratory phase and an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the absolute value, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the absolute value exceeds a predetermined value.

33. The apparatus according to claim 28, wherein the controller is adapted to determine a length of an expiratory phase of the breath as indicated by the I/E state signal, wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the length of an expiratory phase does not exceed a predetermined percentage of a length of an inspiratory phase of the breath as indicated by the I/E state signal.

34. The apparatus according to claim 28, wherein the controller is adapted to determine a length of an expiratory phase of the breath as indicated by the I/E state signal, wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the length of an expiratory phase does not exceed a predetermined duration.

35. The apparatus according to claim 28, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, wherein the controller is further adapted to generate a dyssynchrony flag waveform based on the plurality of dyssynchronies.

36. The apparatus according to claim 28, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, wherein the controller is further adapted to modify operation of the pressure support system based on the plurality of dyssynchronies.

37. The apparatus according to claim 28, the declaring a dyssynchrony comprising declaring a plurality of dyssynchronies for a plurality of breaths based on the patient flow data and the I/E state signal, wherein the controller is further adapted to detect information about a condition of the patient based on the plurality of dyssynchronies.

38. An apparatus for detecting dyssynchorny between a patient and a pressure support system, comprising:

a housing separate from the pressure support system; and

a controller provided within the housing and operatively coupled to the pressure support system, the controller being adapted to detect dyssynchorny between the patient and the pressure support system by;

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing a flow of gas provided to the patient by the pressure support system,

obtaining an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchorny for the breath and outputting a dyssynchorny indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchorny is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, wherein the controller is adapted to determine an incremental tidal volume from the patient flow data for at least a portion of an expiratory phase of the breath as indicated by the I/E state signal, wherein the at least one of a number of predetermined criterion is based on the incremental tidal volume, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the incremental tidal volume exceeds a predetermined positive value.

39. An apparatus for detecting dyssynchorny between a patient and a pressure support system, comprising:

a housing separate from the pressure support system; and

a controller provided within the housing and operatively coupled to the pressure support system, the controller being adapted to detect dyssynchorny between the patient and the pressure support system by;

receiving patient flow data representing a patient flow waveform, the patient flow waveform representing a flow of gas provided to the patient by the pressure support system;

obtaining an I/E state signal indicating whether a current respiratory phase of the patient is inspiratory or expiratory, the I/E state signal being in binary form and having only a first binary state and a second binary state, the first binary state indicating that the current respiratory phase is inspiratory and the second binary state indicating that the current respiratory phase is expiratory; and

analyzing both the patient flow data and the I/E state signal for a breath to determine whether at least one of a number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal and declaring a dyssynchorny for the breath and outputting a dyssynchorny indicator if it is determined that at least one of the number of predetermined criterion is satisfied based on both the patient flow data and the I/E state signal, wherein the dyssynchorny is a condition where a respiratory drive of the patient is out of sync with breaths being generated by the pressure support system, wherein the controller is adapted to determine a tidal volume from the patient flow data for an inspiratory phase of the breath as indicated by the I/E state, wherein the at least one of a number of predetermined criterion is based on the tidal volume, and wherein the declaring a dyssynchrony comprises declaring the dyssynchrony for the breath if it is determined that the tidal volume is less than a predetermined negative value.